Kaohsiung Journal of Medical Sciences (2018) 34, 467e474

Available online at www.sciencedirect.com

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journal homepage: http://www.kjms-online.com

Original Article

Boredom proneness and its correlation with

Internet addiction and Internet activities in
adolescents with attention-deficit/hyperactivity
disorder
Wen-Jiun Chou a, Yu-Ping Chang b, Cheng-Fang Yen c,d,*

a
Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital, Kaohsiung
Medical Center and College of Medicine, Chang Gung University, Kaohsiung, Taiwan
b
School of Nursing, The State University of New York, University at Buffalo, NY, USA
c
Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
d
Department of Psychiatry, School of Medicine, and Graduate Institute of Medicine, College
of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

Received 2 October 2017; accepted 30 January 2018

Available online 15 February 2018

KEYWORDS Abstract This study examined the associations of boredom proneness with Internet addiction
Attention-deficit/ and activities as well as the moderators for such associations in adolescents with attention-
hyperactivity deficit/hyperactivity disorder (ADHD). In total, 300 adolescents with ADHD participated in this
disorder; study. Their Internet addiction, the scores for lack of external and internal stimulation on the
Boredom proneness; Boredom Proneness Scale-short form (BPS-SF), ADHD, parental characteristics, and the types
Internet addiction; of Internet activities were examined. The associations of boredom proneness with Internet
Internet gaming addiction and Internet activities and the moderators of the associations were examined using
logistic regression analyses. Higher scores for lack of external stimulation on the BPS-SF were
significantly associated with a higher risk of Internet addiction. Maternal occupational socio-
economic status moderated the association of lack of external stimulation with Internet addic-
tion. Higher scores for lack of external stimulation were significantly associated with a high
tendency to engage in online gaming, whereas higher scores for lack of internal stimulation
were significantly associated with a low tendency to engage in online studies. Lack of external
stimulation on the BPS-SF should be considered a target in prevention and intervention
programs for Internet addiction among adolescents with ADHD.
Copyright ª 2018, Kaohsiung Medical University. Published by Elsevier Taiwan LLC. This is an
open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/
by-nc-nd/4.0/).

Conflicts of interest: All authors declare no conflicts of interests.

* Corresponding author. Department of Psychiatry, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Rd, Kaohsiung, 807, Taiwan.
E-mail address: chfaye@cc.kmu.edu.tw (C.-F. Yen).

https://doi.org/10.1016/j.kjms.2018.01.016
1607-551X/Copyright ª 2018, Kaohsiung Medical University. Published by Elsevier Taiwan LLC. This is an open access article under the CC
BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
468
Introduction
Internet addiction has substantial adverse effects on
physical and mental health and interpersonal relationships;
it also diminishes the academic performance of adolescents
[1]. Attention-deficit/hyperactivity disorder (ADHD) is the
most common psychiatric disorder among adolescents with
Internet addiction [2]. The risk of Internet addiction was
significantly associated with the severity of ADHD symptoms
among adolescents in community [3]. A prospective com-
munity study also indicated that ADHD predicts the occur-
rence of Internet addiction in adolescents during a 2-year
follow-up period [4]. The results of previous studies sup-
port the observation that Internet addiction warrants early
prevention in adolescents with ADHD.
Boredom proneness is one of the possible etiologies
responsible for the high risk of Internet addiction among
individuals with ADHD [5]. Mikulas and Vodanovich [6]
defined boredom as “a state of relatively low arousal and
dissatisfaction, which is attributed to an inadequately
stimulating environment.” Perkins and Hill [7] expounded
boredom as “cognitive changes in the direction of less
differentiated and more homogeneous construing give rise
to a state of subjective monotony which induces, or perhaps
even represents, the state.” Boredom has been found to be
significantly associated with problems of negative affect,
behavior, interpersonal relationships, and occupations [8].
In addition, boredom has been identified as one of common
causes of addictive substance use [9]. Boredom is one of the
common triggers of intensive Internet use [10], and it is
significantly associated with Internet addiction [11] and
Internet-related functional impairment [12] in university
students. High boredom proneness is also one of the risk
factors for online gambling in young adults [13].
High boredom proneness has been considered one of the
core symptoms in individuals with ADHD, which usually re-
sults in impaired academic function and difficulties in inter-
personal relationships [14]. Adults with high boredom
proneness performed poorly on measures of sustained
attention and exhibited increased symptoms of ADHD [15].
Given that Internet use can provide rapid responses, imme-
diate rewards, and multiple windows with different activ-
ities, which may reduce the feeling of boredom, the
hypothesis that high boredom proneness is significantly
associated with the risk of Internet addiction among ado-
lescents with ADHD is reasonable [5]. However, several issues
regarding the association between boredom proneness and
Internet addiction in adolescents with ADHD warrant further
study. First, a previous study reported that leisure boredom
increases the probability of Internet addiction in adolescents
[16]. However, the relationship between general boredom
proneness and Internet addiction in adolescents with a clin-
ical diagnosis of ADHD has not been examined. Second,
boredom proneness consists of various factors. For example,
the Boredom Proneness Scale-short form (BPS-SF) [17] is the
commonly used instrument for measuring general boredom
proneness. The BPS-SF consists of two overall factors, namely
lacks of internal stimulation and external stimulation [10].
The relationships between various components of boredom
proneness and Internet addiction have not been examined.
Third, adolescents may use the Internet for many types of
W.-J. Chou et al.
online activities. Various Internet activities have different
characteristics and provide different types of pleasure.
Whether boredom proneness has various relationships with
different types of Internet activities requires further study.
Fourth, sex [18], age [19], parental socioeconomic status
(SES) [19], and severity of ADHD symptoms [18] are signifi-
cantly associated with Internet addiction in individuals with
ADHD. Meanwhile, sex and age moderated the relationships
of residential background and social activities with Internet
addiction in adolescents [20]. Regarding boredom proneness,
a previous study on psychiatric inpatient population found
that boredom proneness was not associated with age or
gender [21], whereas another study on community popula-
tion found that boredom is more prevalent among men,
youths, the unmarried, and those of lower income [22].
However, whether these factors moderate the association
between boredom proneness and Internet addiction and ac-
tivities in adolescents with ADHD requires further study.
This study examined the associations between boredom
proneness and Internet addiction and activities as well as
the moderating effects of demographic, parental, and
ADHD characteristics on these associations in adolescents
with ADHD. We have three hypotheses. First, the scores for
the lack of internal stimulation and external stimulation on
the BPS-SF measuring boredom proneness are significantly
associated with the risk of Internet addiction in adolescents
with ADHD. Second, boredom proneness has various re-
lationships with different types of Internet activities. Third,
due to the scarcity of previous studies, we hypothesized
that the demographic, parental, and ADHD characteristics
moderate the association between boredom proneness and
Internet addiction and activities in adolescents with ADHD.
Methods
Participants
The participants for this study were recruited from the
child and adolescent psychiatric outpatient clinics of two
medical centers in Kaohsiung, Taiwan. Adolescents aged
between 11 and 18 years, who had received a diagnosis of
ADHD according to the diagnostic criteria in the Diagnostic
and Statistical Manual of Mental Disorders 5th edition (DSM-
5) [23], were consecutively invited to participate in this
study between August 2013 and July 2015. ADHD was
diagnosed on the basis of multiple data sources including (i)
an interview with a child psychiatrist; (ii) clinical observa-
tion of the participant’s behavior; and (iii) a history pro-
vided by the parents and the short version of the Swanson,
Nolan, and Pelham, Version IV Scale-Chinese version (SNAP-
IV) [24]. Adolescents with intellectual disabilities, schizo-
phrenia, bipolar disorder, autistic disorder, difficulties in
communication, or any cognitive deficits that adversely
affected their ability to understand the study purpose or
complete the questionnaires were excluded. A total of 333
adolescents with the diagnosis of ADHD were enrolled for
this study. Among them, 300 (90.0%) agreed to participate
in this study and were interviewed by research assistants
using a research questionnaire. Of the 33 adolescents who
refused to join this study, 19 and 14 refused on the basis of
their parents’ and their own opinions, respectively. The
Internet Addiction in ADHD
Institutional Review Boards of Kaohsiung Medical University
and Chang Gung Memorial Hospital, Kaohsiung Medical
Center, approved the study.
Measures
Boredom proneness
The present study applied the BPS-SF [17] to measure the
participants’ trait susceptibility to boredom. The BPS-SF is a
self-report questionnaire consisting of 12 items rated on a 7-
point Likert scale. The BPS-SF is composed of two subscales:
internal stimulation (6 items; e.g., “I find it easy to entertain
myself.”) and external stimulation (6 items; e.g., “Unless I
am doing something exciting, even dangerous, I feel half-
dead and dull.”) [17]. The internal stimulation subscale in-
dicates boredom due to one’s inability to generate inter-
esting activities, whereas the external stimulation subscale
indicates the perception of low environmental stimulation.
After the scores of the items on the internal stimulation
subscale are transformed, higher total scores on the two
BPS-BF subscales indicate higher levels of lack of internal
stimulation and external stimulation. We translated the
English version of the BPS-SF to Chinese by using standard
forward-, backward-, and pretest-step methods. The inter-
nal consistency (Cronbach’s a) values of the internal stim-
ulation and external stimulation subscales of the BPS-SF in
the present study were .71 and .74, respectively.
Internet addiction and activities
We used the Chen Internet Addiction Scale (CIAS) to assess
the severity of the participants’ Internet addiction levels
over 1 month prior to the study. The CIAS contains 26 items
to be rated on a 4-point Likert scale with scaled scores
ranging from 26 to 104 [25]. A high total score indicates
severe Internet addiction. The internal reliability (Cron-
bach’s a) of the CIAS in the present study was .94. The 63/
64 cutoff point has the highest diagnostic accuracy, sensi-
tivity, and specificity for Internet addiction [26]. We also
questioned whether the participants engaged in the four
most common Internet activities among adolescents in
Taiwan, namely online gaming, online chatting, watching
movies online, and online studying [27].
Parental factors
The present study examined the marital status of each
participant’s parents (married and living together vs.
divorced or separated). The participants’ parental occu-
pational SES was assessed using the Close-Ended Ques-
tionnaire of the Occupational Survey (CEQ-OS) [28], which
classifies paternal and maternal occupational SES into five
levels; a high level indicates a high occupational SES. The
reliability and validity of the CEQ-OS have been proven to
be acceptable, and the CEQ-OS has frequently been used in
studies on children and adolescents in Taiwan [28]. In the
present study, levels I, II, and III of the CEQ-OS were clas-
sified as low occupational SES, whereas levels IV and V were
classified as high occupational SES.
ADHD characteristics
The short version of the SNAP-IV-Chinese version was used
to rate the core ADHD subscales of inattention and
469
hyperactivity/impulsivity of the participants during the 1-
month period prior to the study [24]. Each of the items was
rated on a 4-point Likert scale from 0 (not at all ) to 3 (very
much). The Cronbach’s a values of the inattention and
hyperactivity/impulsivity subscales in the present study
were .80 and .89, respectively. The high total scores on the
subscales indicated severe ADHD symptoms. The pre-
sentations of ADHD specified by the participants, including
predominantly inattentive, predominantly hyperactive/
impulsive, or combined presentations, were determined by
child psychiatrists on the basis of the diagnostic criteria in
the DSM-5 [23]. The child psychiatrists also recorded
whether the participants received medication for ADHD at
the time of the study.
Procedure
The research assistants conducted interviews using the BPS,
CIAS, and questionnaire for Internet activities to collect
data from the adolescent participants. Adolescents’ par-
ents completed the SNAP-IV under the direction of the
research assistants.
Statistical analysis
Data analysis was performed using SPSS 20.0 (SPSS Inc.,
Chicago, IL, USA). The associations between boredom
proneness and Internet addiction and engagement in
Internet activities were examined using logistic regression
analysis to control the confounding effects of the de-
mographic and ADHD characteristics and family factors. P
value, odds ratios (ORs) and 95% confidence intervals (CIs)
were used to present the significance. A two-tailed p value
of less than .05 was considered statistically significant.
We also used the criteria proposed by Baron and Kenny
[29] to examine the moderators for the associations be-
tween boredom proneness and Internet addiction and ac-
tivities. According to the criteria, moderation occurred
when the interaction term between the predictors
(boredom proneness) and the hypothesized moderators was
significantly associated with the dependent variable
(Internet addiction and activities) after the main effects of
both the predictors and hypothesized moderator variables
were controlled for. In this study, if boredom proneness and
possible moderators were significantly associated with
Internet addiction and activities in the logistic regression
analysis, the interactions (boredom proneness  possible
moderators) were further selected for logistic regression
analyses to examine their moderating effects.
Results
The participants’ demographic, parental, and ADHD char-
acteristics, Internet addiction and activities, and boredom
proneness are presented in Table 1. Of the participants, 259
(86.3%) were boys and 41 (13.7%) were girls. The mean age
was 12.8 years (standard deviation [SD] Z 1.8 years). In
total, 213 (71.0%), 71 (23.7%), and 16 (5.3%) participants
were identified as having combined, predominantly inat-
tentive, and predominantly hyperactive/impulsive pre-
sentations, respectively. In total, 42 (14.0%) participants
470 W.-J. Chou et al.

Table 1 Demographic characteristics, ADHD and Internet usage characteristic, and the levels of boredom proneness
(N Z 300).
n (%) Mean (SD) Range
Sex
Girls 41 (13.7)
Boys 259 (86.3)
Age (years) 12.8 (1.8) 10e18
Parental marriage status
0: married and live together 231 (77.0)
1: divorced or separated 69 (23.0)
Paternal occupational socioeconomic status
0: high 125 (41.7)
1: low 175 (58.3)
Maternal occupational socioeconomic status
0: high 94 (31.3)
1: low 206 (68.7)
ADHD symptoms on the SNAP-IV
Inattention 12.7 (5.8) 0e27
Hyperactivity/impulsivity 8.8 (6.0) 0e27
Receiving medication for ADHD 254 (84.7)
Severity of Internet addiction on the CIAS 47.7 (14.1) 25e95
Having Internet addiction 42 (14.0)
Internet activities
Online gaming 264 (88.0)
Online chatting 212 (70.7)
Online watching movie 248 (82.7)
Online studying 100 (33.3)
Boredom proneness on the BPS-SF
Lack of internal stimulation 24.6 (7.0) 6e42
Lack of external stimulation 18.3 (7.5) 6e42
ADHD: attention-deficit/hyperactivity disorder; BPS-SF: Boredom Proneness Scale-Short Form; CIAS: Chen Internet Addiction Scale;
SNAP-IV: Swanson, Nolan, and Pelham, Version IV Scale.

were classified as having Internet addiction. The percent-
ages of participants who engaged in online gaming, online
chatting, online movie watching, and online studying were
88.0%, 70.7%, 82.7%, and 33.3%, respectively. The mean
scores on the internal stimulation and external stimulation
subscales of the BPS were 24.6 (SD Z 7.0) and 18.3
(SD Z 7.5), respectively.
The results obtained from examining the associations
between boredom proneness and Internet addiction are
listed in Table 2. The results indicate that after the effects
of other factors were controlled for, a higher score for lack
of external stimulation on the BPS-SF was significantly
associated with a higher risk of Internet addiction
(OR Z 1.103, 95% CI: 1.049e1.159).

Table 2 Associated factors of Internet addiction: logistic regression analysis.

Internet addiction
Wals c2 p OR 95% CI of OR
Sex .397 .529 .727 .270e1.960
Age .196 .658 1.045 .859e1.273
Broken parental marriage status 1.650 .199 .534 .205e1.391
Low paternal occupational socioeconomic status 2.286 .131 1.898 .827e4.357
Low maternal occupational socioeconomic status 5.711 .017 3.672 1.264e10.670
Inattention on the SNAP-IV 1.460 .227 1.050 .970e1.138
Hyperactivity/impulsivity on the SNAP-IV .000 .988 .999 .925e1.080
Receiving medication for ADHD 1.275 .259 .599 .246e1.458
Lack of internal stimulation on the BPS-SF .607 .436 1.022 .967e1.081
Lack of external stimulation on the BPS-SF 14.853 .000 1.103 1.049e1.159
ADHD: Attention-deficit/hyperactivity disorder; BPS-SF: Boredom Proneness Scale-Short Form; SES: socioeconomic status; SNAP-IV:
Swanson, Nolan, and Pelham, Version IV Scale.
Internet Addiction in ADHD 471

Because of the significant association between low
maternal occupational SES and Internet addiction
(OR Z 3.672, 95% CI: 1.264e10.670), the interaction be-
tween low maternal occupational SES and lack of external
stimulation was included in the logistic regression analysis.
The result indicated that the interaction between maternal
occupational SES and lack of external stimulation was
significantly associated with Internet addiction (OR Z 1.252,
95% CI: 1.070e1.464), indicating that maternal occupational
SES moderated the association between lack of external
stimulation and Internet addiction. The results of further
examination revealed that a significant association between
lack of external stimulation and Internet addiction was
observed only in participants with low maternal occupa-
tional SES (OR Z 1.149, 95% CI: 1.082e1.221) but not in
participants with high maternal occupational SES
(OR Z .923, 95% CI: .786e1.082).
The results of examining the association between
boredom proneness and engagement in Internet activities
are presented in Table 3. The results indicate that higher
scores for lack of external stimulation on the BPS-SF were
significantly associated with a high tendency to engage in
online gaming (OR Z 1.109, 95% CI: 1.043e1.180); however,
the higher scores were not significantly associated with
online chatting (OR Z .994, 95% CI: .957e1.032), online
movie watching (OR Z 1.003, 95% CI: .961e1.047), or on-
line studying (OR Z 1.028, 95% CI: .993e1.064).
Because of a significant association between sex and
engagement in online gaming (OR Z 4.991, 95% CI:
2.075e12.009), the interaction between sex and lack of
external stimulation was included in the logistic regression
analysis. However, the interaction between sex and lack of
external stimulation was not significantly associated with
engagement in online gaming (OR Z .982, 95% CI:
.859e1.123), thereby indicating that sex did not moderate
the association between lack of external stimulation and
engagement in online gaming.
Higher scores for lack of internal stimulation on the BPS-
SF were significantly associated with a low tendency to
engage in online studying (OR Z .962, 95% CI: .926-.999);
however higher scores were not significantly associated
with online gaming (OR Z 1.006, 95% CI: .952e1.064), on-
line chatting (OR Z .980, 95% CI: .941e1.020), or online
movie watching (OR Z .994, 95% CI: .949e1.040).
Because of a significant association of age (OR Z 1.164,
95% CI: 1.009e1.342) and low maternal occupational SES
(OR Z 2.141, 95% CI: 1.169e3.920) with engagement in
online studying, the interaction of age and low
maternal occupational SES with internal stimulation was
included in the logistic regression analysis. However,
neither the interaction between age and internal stimula-
tion (OR Z .993, 95% CI: .972e1.014) nor that between low
maternal occupational SES and internal stimulation
(OR Z .974, 95% CI: .895e1.060) was significantly associ-
ated with engagement in online studying, thereby indi-
cating that neither age nor low maternal occupational SES
moderated the association between the lack of internal
stimulation and engagement in online studying.

Table 3 Table 2 Associated factors of Internet activities: logistic regression analysis.

Online gaming Online chatting
Wals c 2
p OR 95% CI of OR Wals c2 p OR 95% CI of OR
Sex 12.883 <.001 4.991 2.075e12.009 .009 .923 .961 .428e2.157
Age .863 .353 .906 .736e1.116 29.574 .000 1.763 1.437e2.162
Broken parental marriage status .067 .796 1.130 .446e2.866 .017 .896 1.044 .551e1.978
Low paternal occupational SES .143 .705 .852 .371e1.957 .337 .562 .840 .465e1.515
Low maternal occupational SES .912 .339 .639 .255e1.601 .322 .570 .836 .451e1.550
Inattention 1.135 .287 .956 .880e1.039 .028 .867 1.005 .944e1.070
Hyperactivity/impulsivity .200 .654 1.019 .938e1.107 1.024 .312 .970 .913e1.029
Receiving medication for ADHD 1.917 .166 .386 .100e1.486 .005 .946 .972 .431e2.193
Lack of internal stimulation on the BPS-SF .051 .822 1.006 .952e1.064 1.007 .316 .980 .941e1.020
Lack of external stimulation on the BPS-SF 10.831 .001 1.109 1.043e1.180 .113 .737 .994 .957e1.032
Online watching movie Online studying
Wals c 2
p OR 95% CI of OR Wals c2 p OR 95% CI of OR
Sex 1.669 .196 .481 .159e1.460 .080 .778 .900 .434e1.869
Age 8.441 .004 1.368 1.107e1.689 4.350 .037 1.164 1.009e1.342
Broken parental marriage status 1.231 .267 1.561 .711e3.427 .519 .471 1.253 .678e2.317
Low paternal occupational SES 1.804 .179 .620 .308e1.246 .051 .821 .939 .541e1.627
Low maternal occupational SES .063 .801 1.095 .540e2.220 6.084 .014 2.141 1.169e3.920
Inattention .051 .821 .992 .922e1.066 .159 .690 1.012 .956e1.071
Hyperactivity/impulsivity .002 .967 1.001 .935e1.073 1.756 .185 .963 .910e1.018
Receiving medication for ADHD .359 .549 1.309 .543e3.157 .160 .689 1.159 .563e2.387
Lack of internal stimulation on the BPS-SF .077 .781 .994 .949e1.040 4.005 .045 .962 .926e.999
Lack of external stimulation on the BPS-SF .020 .887 1.003 .961e1.047 2.373 .123 1.028 .993e1.064
ADHD: Attention-deficit/hyperactivity disorder; BPS-SF: Boredom Proneness Scale-Short Form; SES: socioeconomic status.
472
Discussion
The present study determined that higher scores for lack of
external stimulation on the BPS-SF were significantly asso-
ciated with a higher risk of Internet addiction. Maternal
occupational SES moderated the association between lack
of external stimulation and Internet addiction. Moreover,
higher scores for lack of external stimulation on the BPS-SF
were significantly associated with a high tendency to
engage in online gaming, whereas higher scores for lack of
internal stimulation on the BPS-SF were significantly asso-
ciated with a low tendency to engage in online studying.
Although the cross-sectional research design of the pre-
sent study limited the possibility of drawing a causal rela-
tionship between boredom proneness and Internet addiction
and activities, we proposed several possible etiologies to
account for the significant association between boredom
proneness and Internet addiction and activities in adoles-
cents with ADHD. First, boredom proneness and Internet
addiction may have common biological mechanisms. A pre-
vious functional magnetic resonance imaging (fMRI) study on
individuals playing a first-person shooter video game found
that boredom was related to the activities of insula, amyg-
dala, and bilateral ventromedial prefrontal cortex [30].
Another fMRI study found that boredom was related to the
activities of insula and caudate nucleus [31]. Moreover, fMRI
studies also found that inter-hemispheric insula [32],
amygdalaeinsula [33], amygdalaefrontal [33], and frontos-
triatal [32] functional connections were associated with
Internet gaming disorder. Insula, amygdala, and bilateral
ventromedial prefrontal cortex that are responsible for
emotional regulation, impulse control and motivation are
involving in both boredom proneness and Internet addiction.
Second, boredom proneness may contribute to the
development of Internet addiction and a preference for
some varieties of Internet activities in adolescents with
ADHD. Lack of external stimulation on the BPS-SF indicates
the perception of low environmental stimulation; specif-
ically, the BPS-SF items on the external stimulation sub-
scale reflect a need for variety and change [8]. ADHD
adolescents with high scores for lack of external stimula-
tion may have difficulties in experiencing interest from
daily activities and pleasure from leisure time. Internet use
can conveniently provide users with various activities and
enjoyment with rapid response, which may reduce the
feeling of boredom. When compared with other Internet
activities, online gaming frequently provides adolescent
users with feelings that are different from the usual expe-
riences in their daily lives; hence, adolescents with ADHD
with high scores for lack of external stimulation on the BPS-
SF are attracted to engage in online gaming. Lack of in-
ternal stimulation indicates boredom due to one’s inability
to generate interesting activities; specifically, the BPS-SF
items on the internal stimulation subscale refer to a
perceived inability to generate sufficient stimulation for
oneself [8]. Although the present study did not show a
significant association between lack of internal stimulation
on the BPS-SF and Internet addiction, higher scores for lack
of internal stimulation were significantly associated with a
low tendency to engage in online studying. Online studying
has become a trend for modern learning. Although online
W.-J. Chou et al.
studying involves more vivid and vigorous learning than
does traditional studying in classrooms, adolescents with
ADHD with high scores for lack of internal stimulation on
the BPS-SF may still perceive an inability to generate suf-
ficient stimulation for themselves to study.
Third, other factors such as psychopathology and per-
sonality characteristics may contribute to the significant
association between boredom proneness and Internet
addiction in adolescents with ADHD. For example, studies
have indicated that boredom proneness is significantly
associated with depression [34], anxiety [34], and hostility
[35]. Moreover, depression and anxiety are significantly
associated with Internet addiction in adolescents with
ADHD [36]. Depression, social phobia, and hostility predict
the occurrence of Internet addiction among adolescents in
a 2-year follow-up [4]. Regarding personality characteris-
tics, sensation seeking is not only one of the manifestations
of boredom proneness but also significantly associated with
Internet addiction in adolescents with ADHD [19]. Thus,
further study is warranted to examine whether psychopa-
thologies and personality characteristics contribute to the
co-occurrence of boredom proneness and Internet addic-
tion or mediate the significant association between
boredom proneness and Internet addiction.
Fourth, Internet addiction may aggravate boredom
proneness in adolescents with ADHD. The Internet provides
adolescents with various activities, rapid responses, and
immediate rewards, which are very different from the ado-
lescents’ experiences in real environments. Adolescents with
ADHD may experience less boredom in online environments
but may experience more severe boredom in the virtual
world. However, the hypothesis requires further study.
The present study found that maternal occupational SES
moderated the association between lack of external stim-
ulation and Internet addiction. A significant association
between lack of external stimulation and Internet addiction
was found only in those with low maternal occupational SES
and not in those with high maternal occupational SES.
Studies have revealed that families with low SES were more
likely to have a sedentary lifestyle than were those with
high SES [37]. In most Taiwanese families, mothers typically
manage their children’s daily behaviors. The mothers’
occupational SES may substantially influence their knowl-
edge of computers and the Internet. Consequently, mothers
with less knowledge of computers and the Internet have a
low capacity for monitoring and controlling their adoles-
cents’ Internet use; thus, the risk of Internet addiction in-
creases in adolescents with ADHD and causes high boredom
proneness.
Several limitations in our investigation must be dis-
cussed. First, the cross-sectional design of this study
limited our ability to conclude regarding the causal re-
lationships between boredom proneness and Internet
addiction. Second, the participants of the present study
were recruited from clinical units. Additional studies are
required to examine whether the results of the present
study can be generalized to adolescents with ADHD who do
not visit clinical units to receive treatment. Third, the
present study did not examine how the associations be-
tween boredom proneness and Internet addiction develop.
As mentioned, psychopathology and personality charac-
teristics may contribute to the co-occurrence of boredom
Internet Addiction in ADHD
proneness and Internet addiction; thus, the roles of psy-
chopathology and personality characteristics in the associ-
ation between boredom proneness and Internet addiction
in adolescents with ADHD warrant further study. Fourth, no
control group was recruited in the present study, and thus it
is unclear whether high boredom proneness results in a
higher risk of Internet addiction among adolescents with
ADHD compared than those without ADHD. Fifth, the psy-
chometrics of Chinese version of the BPS-SF warrants
further examination.
Based on the results of the present study, we suggest that
mental health and educational professionals should
routinely evaluate boredom proneness in adolescents with
ADHD. Furthermore, they should monitor the risk of Internet
addiction in adolescents with ADHD with high scores for lack
of external stimulation on the BPS-SF. Prevention and
intervention programs for Internet addiction and overuse of
Internet gaming must consider adolescents’ boredom
proneness and maternal occupational SES. Because that
emotional regulation, impulse control and motivation are
involving in both boredom proneness and Internet addiction,
prevention and intervention programs should take these
psychological characteristics into consideration. For
example, research found that methylphenidate treatment
can reduce the severity of problematic Internet faming in
children with ADHD [38]. It is possible that methylphenidate
may improve ADHD children’s impulse control and then
reduce Internet gaming. Moreover, early identification of
children and adolescents with emotional dysregulation and
providing cognitive-behavioral therapy for them may reduce
the risk of developing Internet addiction among the ADHD
youths with high boredom proneness. Shek and colleagues
also developed an Internet addiction treatment program for
Chinese adolescents in Honk Hong [39]. The program en-
hances adolescents’ motivation to self-arrange their daily
lives and invite the parents of adolescents to learn skills for
communicating with adolescents to enhance their self-
control. The model of adolescent-parent working together
may result in the reduction of boredom feeling and then
improve adolescents’ Internet addiction.
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Appendix A. Supplementary data
Supplementary data related to this article can be found at
https://doi.org/10.1016/j.kjms.2018.01.016.